Organization
GATEWAY PSYCHOLOGICAL SERVICES, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE ANN DILLON PH.D. (OWNER)
(630) 896-2337
Entity
Organization
Contact information
Practice address
412 N LAKE ST, SUITE 204, AURORA, IL 60506-4106
(630) 896-2337
(630) 896-3515
Mailing address
412 N LAKE ST, SUITE 204, AURORA, IL 60506-4106
(630) 896-2337
(630) 896-3515
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071004310
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4515275
BC BS OF ILLINOIS
IL
01
—
4572030
BC BS OF ILLINOIS
IL
Enumeration date
09/18/2007
Last updated
10/19/2012
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